The patient was an 11‐year‐old boy with inoperable cerebellar medulloblastoma twice previously treated with radiotherapy. A preterminal comatose stage developed 3 years, 10 months after the tumor was first diagnosed. A remarkable remission occurred after chemotherapy was administered, beginning with vincristine intravenously alternating with cyclophosphamide intravenously weekly. Intrathecal methotrexate was added and all three drugs were continued for 6 months. Then only oral cyclophosphamide was given for an additional 6 months. A fatal relapse occurred one year later and the patient died despite another course of intrathecal methotrexate. Chemotherapy should be administered to any patient with cerebellar medulloblastoma when the tumor persists or recurs after radiotherapy. It would be logical to study the effect of following the initial course of radiotherapy to medullobastomas with chemotherapy. Further research is needed to determine the best chemotherapeutic regime.
Fifteen cases of carcinoma of the thyroid and four cases of thyroid adenoma in children and young adults are reported. In all, except one, irradiation had been given to the head, neck, or chest of these patients 5 to 17 years previously.
These observations suggest that carcinoma of the thyroid in children is related to irradiation, often prescribed for uncertain therapeutic effect. Irradiation to the head, neck, or chest of infants and children should be avoided wherever possible.
We believe these cases represent a remarkably high incidence of thyroid neoplasia to occur in a single practicing pediatric office. The practicing pediatrician who now follows his patients longitudinally from infancy through adolescence has a unique opportunity to observe the development of disease, even years later.
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